HIV infection associated post-traumatic stress disorder and post-traumatic growth--a systematic review

The phenomenon of post-traumatic stress has been well documented in the literature as a lasting mental health condition associated with exposure to traumatic life events. The diagnosis and experience of human immunodeficiency virus (HIV) disease may be such a trauma. On the other hand, the phenomenon of post-traumatic growth (PTG) has been described, whereby people show positive mental health growth in the face of such trauma. This systematic review was set out to explore post-traumatic stress disorder (PTSD) and PTG in people with HIV to monitor prevalence, measurement and efficacy of interventions to reduce stress and/or promote growth. Standardised review techniques were used to track reports on both PTSD and PTG. A total of 206 papers were retrieved from the PTSD and HIV searches, and 13 from the PTG and HIV searches. After reviewing the papers for inclusion according to adequacy and relevance criteria and to remove duplicates, 33 PTSD papers and three PTG were available for full coding. Prevalence of PTSD in HIV ranged from 5% to 74%, which were much greater than the 7-10% in the general population. Seven studies showed a relation between trauma and PTSD, while six showed a link between PTSD diagnosis and reduced antiretroviral treatment adherence. Women were more likely to be diagnosed with PTSD. Only three intervention reports were identified that fitted our inclusion criteria. All of these reported on psychological interventions for HIV+?individuals with trauma. The interventions utilised HIV education, training in coping techniques and support groups. Only coping interventions were shown to be effective. PTG was under researched but showed a promising avenue of study. There needs to be harmonised measurement and the evidence base would need strengthening in order to build on the understanding of the impact of PTSD and PTG over the course of HIV disease. There is good evidence to associate HIV diagnosis and experiences during the course of illness as traumatic. PTSD has been shown to be prevalent and there seems to be good evidence to incorporate standardised measures to track the course of the disorder. There is extremely limited evidence that interventions may affect the course of symptom experience. The evidence and insight into PTG show promise but is currently inadequate.     

A systematic review of interventions for anxiety in people with HIV

People with human immunodeficiency virus (HIV) show elevated anxiety levels compared to the general population. Anxiety can predate HIV infection or be triggered by HIV diagnosis and the many stresses that emerge during the course of HIV disease. Many psychological and pharmacological therapies have been shown to treat anxiety in the general population but a systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review examines all published intervention studies on anxiety and HIV from 1980 to 2009 covered by the databases MedLine (1980-2009) and PsycINFO (1980-2009) for a definitive account of effectiveness of interventions and an indication of prevalence of HIV-related anxiety and measurement within studies. Standard systematic research methods were used to gather quality published papers on HIV and anxiety, searching published data bases according to quality inclusion criteria. From the search, 492 papers were generated and hand searched resulting in 39 studies meeting adequacy inclusion criteria for analysis. Of these, 30 (76.9%) were implemented in North America (the USA and Canada), with little representation from developing countries. Thirty-three (84.6%) studies recruited only men or mostly men. A total of 50 interventions were investigated by the 39 studies; 13 targeted HIV, symptoms or associated outcomes/conditions, 20 directly targeted anxiety and another 17 indirectly targeted anxiety. Twenty-four (48%) interventions were effective in reducing anxiety (including 11 indirect interventions), 16 (32%) were ineffective and 10 (20%) had an unknown effect on anxiety. Sixty-five percent of interventions directly targeting anxiety were effective. Psychological interventions (especially cognitive behavioural stress management interventions and cognitive behavioural therapy) were generally more effective than pharmacological interventions. Only three studies provided prevalence rates - these ranged from 13% to 80%. Anxiety was measured using 16 different instruments. Our detailed data suggest that interventions are both effective and available, although further research into enhancing efficacy would be valuable. Also, the vast majority of studies were Western-based, no studies looked at children or adolescents and few looked specifically at women. An international effort to harmonise measurement of anxiety is also missing. There is a need to routinely log anxiety in those with HIV infection during the course of their disease, to provide specific data on women, young people and those in diverse geographic areas and incorporate management into care protocols.     

Promoting response variability and stimulus generalization in martial arts training

The effects of reinforcement and extinction on response variability and stimulus generalization in the punching and kicking techniques of 2 martial arts students were evaluated across drill and sparring conditions. During both conditions, the students were asked to demonstrate different techniques in response to an instructor's punching attack. During baseline, the students received no feedback on their responses in either condition. During the intervention phase, the students received differential reinforcement in the form of instructor feedback for each different punching or kicking technique they performed during a session of the drill condition, but no reinforcement was provided for techniques in the sparring condition. Results showed that both students increased the number of different techniques they performed when reinforcement and extinction procedures were conducted during the drill condition, and that this increase in response variability generalized to the sparring condition.     

Comparison of fundus autofluorescence and minimum-motion measurements of macular pigment distribution profiles derived from identical retinal areas

The optical density of macular pigment was measured at twelve retinal locations in ten subjects by minimum motion photometry, comparing 460 nm with 580 nm or 550 nm. Fundus autofluorescence images were obtained for the same subjects with a scanning laser ophthalmoscope. Optical density was computed from mean calibrated grey-scale values for a central circular field and for annular segments, identical to areas tested psychophysically, and for complete annuli. Psychophysical assessments of optical density were similar irrespective of whether 550 nm or 580 nm was used. Optical density values derived psychophysically showed a linear correlation with assessments based on identical sampled areas of annular segments (slope = 0.98, r2 = 0.97) or complete annuli (slope = 0.89, r2 = 0.96) in autofluorescence images.     

A functional analytic approach to computer-interactive mathematics

Following a pretest, 11 participants who were naive with regard to various algebraic and trigonometric transformations received an introductory lecture regarding the fundamentals of the rectangular coordinate system. Following the lecture, they took part in a computer-interactive matching-to-sample procedure in which they received training on particular formula-to-formula and formula-to-graph relations as these formulas pertain to reflections and vertical and horizontal shifts. In training A-B, standard formulas served as samples and factored formulas served as comparisons. In training B-C, factored formulas served as samples and graphs served as comparisons. Subsequently, the program assessed for mutually entailed B-A and C-B relations as well as combinatorially entailed C-A and A-C relations. After all participants demonstrated mutual entailment and combinatorial entailment, we employed a test of novel relations to assess 40 different and complex variations of the original training formulas and their respective graphs. Six of 10 participants who completed training demonstrated perfect or near-perfect performance in identifying novel formula-to-graph relations. Three of the 4 participants who made more than three incorrect responses during the assessment of novel relations showed some commonality among their error patterns. Derived transfer of stimulus control using mathematical relations is discussed.     

An analysis of choice making in the assessment of young children with severe behavior problems

We examined how positive and negative reinforcement influenced time allocation, occurrence of problem behavior, and completion of parent instructions during a concurrent choice assessment with 2 preschool-aged children who displayed severe problem behavior in their homes. The children were given a series of concurrent choice options that varied availability of parent attention, access to preferred toys, and presentation of parent instructions. The results showed that both children consistently allocated their time to choice areas that included parent attention when no instructions were presented. When parent attention choice areas included the presentation of instructions, the children displayed differential patterns of behavior that appeared to be influenced by the presence or absence of preferred toys. The results extended previous applications of reinforcer assessment procedures by analyzing the relative influence of both positive and negative reinforcement within a concurrent-operants paradigm.     

The effects of stressful arousal on conjugate lateral eye movement

This study investigated the relationship between stressful arousal and conjugate lateral eye movement tendencies in right-handed males. Sixty subjects were asked both neutral and mildly emotional questions after watching either a stressful industrial accident movie or a bland control film. Subjects had been previously classified as either right-movers, left-movers, or bidirectionals on the basis of their responses in a prefilm interview. A statistically significant interaction between dominant direction and film condition was found on right eye movement. Subjects classified as right-movers displayed increased right eye movement preferences under the stress film, compared to the neutral film condition. This effect was seen with neutral, but not mildly emotional, questions. Results were interpreted within an elaborated brain asymmetry model of conjugate lateral eye movement, in which stressful arousal is assumed to increase subjects' reliance on characteristic, neurologically based ways of dealing with stimuli. Implications for theory and research on brain-behavior relationships in ego-defensive styles are discussed.     

Considerations in software character generation

Two concerns about the development of a computer-driven display system to achieve tachistoscopic displays are discussed. Approaches to solving these problems are described.